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Fundus images with poor quality may contain insufficient information to represent characteristics of eye diseases, such as diabetic retinopathy (DR), glaucoma, and age-related macular degeneration (AMD). This negatively affects the performance of automated systems. In this paper, we present a method, which is based on the transfer learning technique with Inception-v3 model, to evaluate the quality of fundus images and eliminate fundus images that are classified as having poor quality. The original Inception-v3 model was modified by adding more layers at the classification layer of the model to adapt to quality fundus image evaluation. The experiment performed acceptable results of quality evaluation for fundus images into two categories: good and poor-quality images. Therefore, the proposed method can assess the quality of the image by identifying the contributing factors such as over dark and over bright.

Purpose To investigate the association between refractive error and horizontal strabismus based on a Korean population-based survey. Methods The study included 22,887 participants >5 years of age who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011. Refractive error was classified into myopia, hyperopia, astigmatism, and anisometropia. The association between refractive error and exodeviation or esodeviation was assessed using multivariate logistic regression analysis. Results After adjusting for potential confounders, the analyses revealed an increased odds ratio (OR) for exodeviation with an increasing trend according to the severity of myopia (mild myopia, OR = 1.36 [95% CI, 1.11-1.66]; moderate myopia, OR = 1.75 [95% CI, 1.36-2.26]; severe myopia, OR = 2.01 [95% CI, 1.50-2.69]; Ptrend Conclusions Refractive error was closely associated with exodeviation and esodeviation. These risk associations should be considered when managing refractive errors.

// Sung-Yong Kim 1 , Suk-Woo Yang 2 , Won-Sik Lee 3 , Jae Wook Yang 4 , Sung Yong Oh 5 , Hee Bae Ahn 6 , Deok-Hwan Yang 7 , Seong Kyu Park 8 , Jee Ho Chang 9 , Hyo Jung Kim 10 , Min Joung Lee 11 and Seok-Goo Cho 12 1 Department of Hematology-Oncology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea 2 Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea 3 Department of Hematology and Oncology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea 4 Department of Ophthalmology, Busan Paik Hospital, Inje University, Busan, Korea 5 Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea 6 Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea 7 Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Jeollanamdo, Korea 8 Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University, Bucheon, Korea 9 Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University, Bucheon, Korea 10 Division of Hematology-Oncology, Department of Internal Medicine, College of Medicine, Hallym University, Hallym University Sacred Heart Hospital, Anyang, Korea 11 Department of Ophthalmology, College of Medicine, Hallym University, Hallym University Sacred Heart Hospital, Anyang, Korea 12 Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea Correspondence to: Seok-Goo Cho, email: chosg@catholic.ac.kr Keywords: lymphoma, ocular, mucosa associated lymphoid tissue, rituximab, chemoimmunotherapy Received: March 09, 2017 Accepted: June 24, 2017 Published: August 02, 2017 ABSTRACT Background: Radiotherapy is a commonly used treatment for limited-stage ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML) but showed a substantial relapse risk if the disease involves beyond-conjunctiva or bilateral conjunctivae. Systemic chemoimmunotherapy may be an alternative frontline therapy for the limited disease with those adverse prognostic factors. Patients and methods: We designed a multicenter, phase II study of the chemoimmunotherapy, rituximab, cyclophosphamide, vincristine, and prednisolone (R-CVP) for the treatment of patients with limited-stage OAML with bilateral or beyond-conjunctival involvement. Thirty-three patients with Ann Arbor stage I OAML with the adverse factors were enrolled. Patients received six cycles of R-CVP followed by two cycles of rituximab therapy. Results: At the end of treatment, all the enrolled patients had responded. The cumulative complete response achievement was 93.9% at 2 years. At a median follow-up of 50.6 months, three patients had progressed. Progression-free survival and overall survival at 4 years was 90.3±5.3% and 100%, respectively. Conclusions: This phase II study demonstrated durable efficacy of R-CVP chemoimmunotherapy, which has promise as an alternative frontline therapy for the limited-stage OAML patients with adverse prognostic factors. Clinical trial registration: NCT01427114.

PURPOSE Previous strabismus appearance studies using images from real face photographs could not preclude the effect of other facial landmarks, such as position and contour of brow, nose, and facial outline, from pure effect of ocular deviation itself. With conceptualized drawings of eyes, we simulated strabismus deviation and collected the responses of observers. METHODS The experiments consisted of three sessions: (1) one-eye, (2) two-eye cornea, and (3) two-eyelid deviation simulations. On a monitor, eight different ocular deviations in increments of 6 prism diopters of horizontal or vertical deviations were simulated. Nine ophthalmology residents were asked to choose between esotropia and exotropia for horizontal simulations and hypotropia or hypertropia for vertical simulations. Psychometric function fitting was performed. Detection sensitivity, point of subjective equality, and 95% thresholds were calculated. RESULTS Between cornea and lid deviation simulations, there was no difference in 95% thresholds, points of subjective equality, and sensitivity (all p values > 0.10), reflecting that the relative location of cornea and lid was the determinant factor in recognizing ocular deviation. The sensitivities of vertical deviation simulations were higher than that of horizontal in two-eye cornea and lid comparisons (p values < 0.04) but not in one-eye (p value = 0.37). CONCLUSIONS Our results suggest that the appearance of strabismus depends not on the absolute ocular alignment but rather on the reciprocal relationship of cornea and lid margin. Vertical misalignment was more apparent than horizontal misalignment.

To investigate the outcomes of strabismus surgery in patients with a prior history of a scleral buckling procedure for retinal reattachment.We reviewed the medical records of 18 patients who underwent strabismus surgery following a scleral buckling procedure and investigated the effect of multiple variables on postoperative alignment after strabismus surgery including gender, age, surgeon, number of strabismus surgeries, adjustable suture use, previous pars plana vitrectomy, preoperative best-corrected visual acuity, and scleral buckle removal. Outcomes were considered successful if there was ≤ 10 prism diopters (PD) residual horizontal and/or ≤ 4 PD residual vertical deviations. Statistical analyses were performed using Fisher's exact test, Mann-Whitney test, and nominal logistic regression.Success using our criteria of motor alignment was achieved in 6 of 18 eyes (33%). A higher rate of success was found in the scleral buckle removal group (success with buckle removal, 62.5%; success without buckle removal, 10.0%; p = 0.04). Nominal logistic regression analysis showed scleral buckle removal was the most significant factor associated with successful surgical alignment (p = 0.03; odds ratio = 16.67). Although the success rate was higher in the adjustable suture group (50% in adjustable group vs 14.3% in non-adjustable group: Fisher's exact test, p = 0.30), this difference was not statistically significant. No retinal redetachments occurred after scleral buckle removal.These results suggest that scleral buckles can be safely removed in selected patients with strabismus following retinal reattachment surgery and scleral buckle removal may improve ocular alignment following strabismus surgery.

Purpose To report a case of bilateral simultaneous angle-closure glaucoma caused by septic condition of Korean hemorrhagic fever. Methods A 62-year-old man visited our emergency center with signs of sepsis (fever, leukocytosis, and oliguria). After 4 days of hospitalization, the patient reported blurred vision. Upon ophthalmologic examination, elevated intraocular pressure, edematous cornea, closed anterior chamber angle, and shallow anterior chamber without iris bowing were found in both eyes in slit-lamp examination and in Pentacam (Oculus, Wetzlar, Germany) Scheimpflug images. Bilateral choroidal effusion was observed on an ultrasound B scan as well. The serologic test for anti-hantaan virus immunoglobulin G (IgG) was positive. Results Along with the sepsis treatment, intravenous hyperosmotic agent, antiglaucoma eye drops, and 1% atropine eye drop were administered immediately. To control the choroidal effusion, systemic steroid was also administered. After 4 months, anterior chamber depth and choroidal effusion were normalized. Conclusions Systemic causes should be considered in patients with bilateral angle-closure glaucoma, and Korean hemorrhagic fever can be one of the causes in endemic areas.

It is known that binocular function is affected by interocular differences in retinal image size, shape, clarity, and illumination. The present study was performed to systematically examine the effects of interocular differences in retinal illuminance on monocular visual acuity, fusion, and stereopsis.Fifty adults with normal binocularity and a best-corrected visual acuity of 20/20 or better were enrolled. We examined best-corrected visual acuity, fusion, and stereoacuity as monocular retinal illuminance was gradually reduced by increasing neutral density filters from 0.2 neutral density (ND; 63% transmission) to 3.0 ND (0.1% transmission) in increments of 0.2 ND. We measured the smallest size of fusion slide by major amblyoscope, and evaluated stereoacuity with the Titmus test and the Lang test.The best-corrected visual acuity began to decrease significantly when the value of the neutral density filter reached 2.0 ND (1% transmission; p0.01). The level of fusion decreased significantly when monocular retinal illuminance was reduced to 2.0 ND (p0.01). Stereoacuity began to decline significantly when the value of the neutral density filter was 1.4 ND (4% transmission) with the Titmus test and 1.6 ND (2.5% transmission) with the Lang test.A binocularly conducted Titmus test was the most sensitive to the presence of monocularly induced retinal illuminance deterioration.

Purpose: Some patients complain of a foreign body sensation, a burning sensation, or dryness after strabismus surgery. We prospectively investigated the changes in corneal and conjunctival sensitivity, tear film stability, and tear secretion after strabismus surgery. Patiente and Methods: Corneal and conjunctival sensitivity were assessed with an esthesiometer, tear film breakup time was measured, and the Schirmer test was performed prospectively (preoperatively and 1 week, 1 month, and 3 months postoperatively) in 83 patients (124 eyes) who underwent strabismus surgery at our institution. Resulte: There were no significant changes in corneal sensitivity, tear film stability, or tear secretion after strabismus surgery (P > .05). Conjunctival sensitivity decreased significantly after strabismus surgery (P < .05). Conclusion: Discomfort and dryness after strabismus surgery do not seem to be related to changes in corneal sensitivity, tear film stability, or tear secretion. J Pediatr Ophthalmol Strabismus 2006;43:95-99.

Aims To investigate the effect of silicone stent intubation (SI) on the quality of life of patients diagnosed with nasolacrimal duct stenosis and dry eye syndrome. Methods This study is a prospective, interventional case series. Consecutive 30 patients diagnosed with nasolacrimal duct stenosis and reflex tearing due to dry eye syndrome were included. Eligible subjects underwent SI and were asked to complete the Glasgow Benefit Inventory (GBI) questionnaire. Surgical outcomes and GBI scores were investigated 6 months postoperatively. Results The surgical success rate determined by the patients’ subjective symptoms was 76.7% (23/30). Mean total GBI score was +17.19 (95% CI 8.34 to 26.03). The general subscale score was +20.36 (95% CI 10.19 to 30.54), the social support scale score was +21.54 (95% CI 11.37 to 31.71) and the physical health score was −0.56 (95% CI −8.92 to 7.80). Conclusions SI could be an effective treatment option for reflex tearing in patients diagnosed with dry eye syndrome and nasolacrimal duct stenosis.

Purpose: To investigate the pathogenesis of a secondary iris cyst with an immunohistochemical method. Methods: Single observational case report. A pathologic specimen was obtained from a 5-year-old girl who was found to have a secondary iris cyst. She had a history of previous penetrating ocular trauma and subsequent cataract surgery and pupilloplasty. Immunohistochemical staining with cytokeratin (CK) 19 and CK3 was used. Results: After immunohistochemical staining, the inner wall showed positive staining for CK19, which is specific for limbal, peripheral cornea and conjunctival epithelium, and negative staining for CK3, which is specific for corneal epithelium. Conclusions: With the aid of immunohistochemical analysis, a conjunctival epithelial origin was indicated, and pupilloplasty was identified as the causal event of the iris cyst while the possibility of primary iris cyst was ruled out.

Purpose: To investigate the expression of laminin-5 during epithelial healing and evaluate its expression in vivo using rat corneas on which amniotic membrane was applied to cover the wound after excimer laser photoablation. Setting: Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. Methods: Myopic photorefractive keratectomy (PRK) with a 100 μm deep ablation was performed in Sprague Dawley rats killed 6, 12, 24, 48, 72, and 96 hours after the procedure. In the first group of 30 rats, the excimer laser-ablated cornea was covered with amniotic membrane after PRK. Thirty other rats in which no amniotic membrane treatment was used served as controls. Immunohistochemical and immunofluorescein techniques were used to monitor the expression of laminin-5, γ2, and γ1 in the rat corneas. Immunoblotting was used to compare the expression of laminin between the amniotic membrane group and the control group. Results: In the immunoblotting study, laminin-5, α3, and γ2 increased 24 hours after amniotic membrane treatment compared to the control group. At 12 hours, in vivo immunostaining of the corneas in both groups expressed laminin, but laminin-5 and γ2 were more intensely expressed in the amniotic membrane group. This continued until reepithelialization. Expression of the γ1 chain was not different between the 2 groups. Conclusion: With the use of amniotic membrane, the expression of laminin-5 and γ2 was faster and more intense than in a control group during reepithelialization of excimer laser-ablated rat corneas.

In this study, we present a case of bilateral dacryocele with orbit magnetic resonance imaging (MRI) images. Otherwise healthy, full term, 46-day-old boy was referred for the evaluation of bilateral orbital mass with both eye discharge. External examination revealed palpable bluish mass on both medial canthus. On orbit MRI images, bilateral cystic masses were visible in his both nasolacrimal duct on T2 weighted MRI images with fluid level on left side. The size of masses had decreased after 3 days of diagnosis. There are only few previous articles describing on MRI findings of dacryocele, especially in bilateral cases. Therefore, we are here to present orbit MRI images of bilateral dacryocele that may be valuable to clinicians interested in congenital nasolacrimal anomalies.

Purpose To assess the differences in work needed for pediatric and adult ophthalmologic examinations. Methods Seven ophthalmology residents conducted slit-lamp and refraction examinations on children 3-7 years of age and adults 20-69 years of age. The examiners reported the magnitude estimate (ME) of their work in relation to two references (cross-reference ME): average adult examination and average pediatric examination. The examination time was also measured. Results For the slit-lamp examination, 50 children and 58 adults were recruited. The ME was 1.45 (95% CI, 1.30-1.62) times higher for the pediatric examinations than for the adult examinations when the reference was an average adult case. With respect to time, the pediatric examinations took 1.22 (95% CI, 1.06-1.41) times longer than the adult examinations. For the refraction examinations, 58 children and 96 adults were recruited. The ME was 1.35 (95% CI, 1.21-1.52) times higher for the pediatric examinations. The pediatric examination took 1.32 (95% CI, 1.16-1.50) times longer than the adult examination. The cross-reference ME ratios measuring the pediatric over adult examinations against both the pediatric and adult reference cases were equivalent in both the slit-lamp and the refraction examinations; however, the ME and time ratios of the pediatric over the adult examinations were not equivalent for the slit-lamp or for the refraction examinations. Conclusions The cross-reference ME showed that pediatric ophthalmologic examinations require more work than the adult examination with validity and reliability. The time estimate was insufficient as a single indicator for work estimation.

The management of exotropia resulting from complete oculomotor nerve palsy is challenging. Conventional therapeutic interventions, including supramaximal resection and recession, superior oblique tendon resection and transposition, and several ocular anchoring procedures have yielded less-than-adequate results. Here we describe a novel surgical technique of anchoring the medial rectus muscle to the medial orbital wall in combination with lateral rectus disinsertion and reattachment to the lateral orbital wall.

Background: Ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML) has an indolent disease course and a generally good response to radiotherapy; hence, limited-stage disease is commonly treated with radiotherapy. However, after localized radiotherapy for limited-stage OAML, a relapse rate of up to 16% was reported and the main relapse sites observed in previous series were in nonirradiated areas. The relapse rate was higher if the disease involved bilateral conjunctivae or tissue beyond the conjunctiva. We designed a phase II study in which patients with newly diagnosed and limited-stage OAML with bilateral or beyond-conjunctival involvement were treated with a regimen of rituximab in combination with cyclophosphamide, vincristine, and prednisolone (R-CVP), which has been widely used for advanced-stage indolent CD20+ B cell lymphoma and in a previous trial has demonstrated efficacy in advanced-stage MALT lymphoma. Patients and methods: Thirty-three patients with Ann Arbor stage I OAML with the adverse factors were enrolled. Patients received six cycles of R-CVP followed by two cycles of rituximab therapy. The enrolment criteria for disease status were Ann Arbor stage IE OAML with bilateral or beyond-conjunctival involvement; bT1 or T>1 based on the tumor-node-metastasis (TNM) staging system for ocular adnexal lymphoma proposed by the American Joint Committee on Cancer. Patients were required to be ©ø18 years old, with Eastern Cooperative Oncology Group (ECOG) performance scores of 0-2, with no prior chemotherapy or radiation therapy. Exclusions were made for disease confined to unilateral conjunctiva (T1N0M0) or Ann Arbor stage III-IV disease. The primary end point of the study was response rate, defined as the CR and partial response (PR) rates, based on the revised response criteria for malignant lymphoma. The secondary end point was PFS and overall survival. Results: The median age of the patients was 49 years (range, 19-74 years). The anatomic location of disease was the conjunctiva in 12 patients (36.4%), the orbit in 13 (39.4%), the eyelid in five (15.2%), and the lacrimal duct or gland in three (9.1%). Fourteen patients (42.4%) had bilateral disease at presentation. All study patients (100%) responded to the treatment. After the treatment, 28 patients (84.8%) were in CR and five patients (15.2%) in PR. With the median follow up of 26.9 months (range, 7.4-41.0 months), the estimated cumulative CR rate was 93.9% at 3 years (Figure 1). The cumulative CR rate was significantly lower in the patients with beyond-conjunctival disease (T>1) than in the patients with bilateral conjunctiva-confined disease (bT1) (91.3% vs. 100%; P = 0.022). The cumulative CR rate was lower for patients aged ©ø49 than in patients younger than 49 years (90.4% vs. 100%; P = 0.034). Multivariate analysis indicated that in our study patients beyond-conjunctival involvement (T>1) was an independent predictor of cumulative CR rate (hazard ratio [HR] 0.424, P = 0.044). Among the study patients, one patient, who had bT1N0M0 disease, relapsed at the same location in the eye at 21.7 months after initiation of treatment. The estimated PFS at 3 years was 95.5 ¡¾ 4.4%. No death was observed and OS was 100%. No patients experienced ophthalmic complications (Figure2). Conclusions: The R-CVP regimen was efficient for disease control up to 3 years because all study patients responded, cumulative CR rate was 93.9% and the PFS was 95.9% at 3 years. The common relapse sites in patients who received radiotherapy were in nonirradiated areas, suggesting that the systemic antitumor coverage of this chemoimmunotherapy may contribute to lowering the risk of distant relapse in our patients. We conclude that the R-CVP regimen can be effective alternative treatment which avoids radiation hazards and efficiently achieves CR in patients with limited-stage OAML, even those with adverse factors of radiotherapy. Disclosures No relevant conflicts of interest to declare.

In cases of extropia with an exodeviation angle over 50 prism diopter (PD), a 3- or 4-muscle surgery is a rational option. But, in patients with sensory exotropia, there is usually a strong preference for a monocular procedure to avoid surgery on the single seeing eye. Thus, we confined surgery to visually poor eyes, and performed a medial rectus muscle resection with a mean of 10.3 mm (range, 9-11 mm) and a lateral rectus muscle recession with a mean of 12.8 mm (range, 10-14 mm) in 4 adult sensory exotropia patients who had a mean deviation of 82.3 PD (range, 75-90 PD). The mean postoperative angle of exodeviation was 2.0 PD (range, ortho-8 PD). The limitation on abduction was not disfiguring. Other expected disfigurements, such as narrowing of the palpebral fissure or enophthalmos, were not conspicuous. The mean follow-up period was 4.5 months (range, 3-7 months). In large-angle sensory exotropia, instead of additive surgery on the seeing eye, supermaximal medial rectus resection and lateral rectus recession only on the visually poor eye is a clinically feasible surgical option.

To report the incidence of, and change in ocular misalignment following topical anesthetic cataract surgery.Prospectively, 160 consecutive patients who were scheduled for cataract surgery under topical anesthesia were evaluated. All patients had a complete ophthalmic examination, including ocular alignment evaluation, just before and 1 day, 1 week, 3 weeks, and 2 months after cataract surgery.Preoperatively, 26 patients had ocular misalignment. Mean deviation in these preexisting misalignment was 7.2 +/- 6.8 prism diopters (PD). Postoperatively, the angle of deviation improved to 5.4 +/- 7.4 PD. Acquired ocular misalignment after cataract surgery occurred in 12 of 160 patients (8%) at 1 day, and seven of 131 (5%) at 2 months. None of these seven patients sought medical attention for the diplopia.The overall incidence of topical anesthesia-related change in ocular alignment after uneventful cataract surgery was 5%. However, no patients had symptomatic diplopia. Topical anesthetic cataract surgery could abolish the risk of postoperative diplopia and improve the heterophoric status of preexisting misalignment.

Purpose: To compare anterior segment measurements between Pentacam and Orbscan II after laser surface ablation. Methods: Corneal thickness, anterior elevation, posterior elevation, and anterior chamber depth more than 1 year after laser refractive surgery were measured using Pentacam and Orbscan II in 51 eyes that underwent laser epithelial keratomileusis (LASEK) and 21 eyes that underwent photorefractive keratectomy (PRK). As controls, the same comparisons were made in 52 unoperated eyes. Results: Mean follow-up was 28.2 months in the LASEK group and 49.9 months in the PRK group. Mean corneal thickness using Pentacam was thicker than that using Orbscan by 10.4 µm in unoperated eyes, 22.6 µm in LASEK eyes, and 11.0 µm in PRK eyes, but the two devices showed good correlation in all groups. Mean anterior elevation was highly correlated between the two devices with 2.1-µm differences in LASEK eyes, but posterior elevation showed no correlation with significant discrepancies. Mean anterior chamber depth was 0.12- to 0.14-µm thicker with Pentacam than with Orbscan, and highly correlated in all groups. Conclusions: Pentacam and Orbscan showed good correlations in corneal thickness, anterior elevation, and anterior chamber depth despite some differences in mean values. The two devices, however, showed no correlation in posterior elevation measurements, a difference that was greater in the postoperative groups. [ J Refract Surg . 2009;25:1091–1097.]

Since Kestenbaum and Anderson, several ophthalmologists have reported the results of different surgical procedures, for abnormal head posture in infantile nystagmus. In this study, we tried to evaluate the surgical results of Parks' original 5-6-7-8 mm modified Kestenbaum procedure and our own 6-7-6-7 mm modified Kestenbaum procedure, designed to reduce some of the problems encountered with other variations of these techniques.Medical records of 92 patients, who had modified Kestenbaum surgery (5-6-7-8 mm or 6-7-6-7 mm) at The Yonsei Medical Center, from March 1991 to September 2001 with a follow-up period of more than 6 months, were reviewed retrospectively. We compared Parks' modified Kestenbaum surgery (5- 6-7-8 mm) performed on 51 patients with our own modified Kestenbaum surgery (6-7-6-7 mm) on 41 patients. Each procedure was done with graded augmentation according to the amount of the face turn and the null point in electro-oculography.In the follow-up of an average 33 months, 45 out of 51 patients (88.2%) who underwent Parks' modified procedures showed face turn less than 10 degrees. In the follow-up of an average 29 months, 36 out of 41 patients (87.8%) with 6-7-6-7 mm procedure had face turn less than 10 degrees.We suggest that 6-7-6-7 mm modified Kestenbaum procedures with a graded augmentation may be a safe and efficient procedure to correct abnormal head posture in infantile nystagmus with a minimum decrease in ocular motility.

Purpose: We investigated the effects of dominant eye and contextual background on predominance during binocular rivalry. Methods: 10 subjects were recruited for the present study. Dominant eye was determined using the hole-in-the-card test. In experiment 1, subjects viewed the stimuli through anaglyph filters and reported the predominance of color. The subject’s responses were compared with the color on the dominant eye. To investigate the influence of color dominance and contextual color, we conducted the experiment with added contextual color information target through switched-anaglyph filters. In experiment 2, the subject viewed the stimuli through the polarized filters and reported the predominance of orientation. The subject's responses were compared with the grating on dominant eye. To rule out the effect of stimulus size, we conducted the experiment with a smaller target. We designed the additional experiment to investigate the influence of contextual grating information on binocular rivalry. Results: 10 subjects were evaluated. In experiment 1, 8 of 10 subjects reported that eye preference was highly correlated with dominant eye. This finding is significant without reference to color. In experiment 2, 7 of 10 subjects reported that eye preference was highly correlated with dominant eye. This finding is significant without reference to size. In experiment 1-2 and 2-2, all subjects reported that predominance of context contradictory target increased. Conclusions: We found the relationship between the dominant eye and eye preference. Experiment 1-2 and 2-2 showed that contradictory contextual information increases target predominance during binocular rivalry. Overall, our results indicate that the contextual background reduce the stimulus strength of the context-congruent target; it would correspond to an increase in the dominance duration of the context-contradictory target. J Korean Ophthalmol Soc 2015;56(12):1953-1960

We report a case of acute transient myopia associated with ciliochoroidal effusion induced by anorexiants. The patient had had myopic laser in situ keratomileusis 7 years earlier. Acute bilateral myopia associated with anterior chamber shallowing, intraocular pressure elevation, diffuse ciliochoroidal effusion, and perimacular retinal folds was relieved 14 days after discontinuation of anorexiant medications. Tropicamide and atropine were used to deepen the anterior chamber. Sympathomimetic drugs such as phendimetrazine and ephedrine are used as anorexiants and may induce transient myopia associated with ciliochoroidal effusion, shallow anterior chamber, and acute angle-closure glaucoma.

A healthy 46-year-old man presented with decreased vision in the right eye after ingestion of raw meat. On funduscopic examination, a cystic lesion was found on an edematous right optic disc with adjacent serous retinal detachment. Optical coherence tomography confirmed a peripapillary serous retinal detachment and a well-demarcated cystic lesion (200 × 200 × 500 μm) in the right eye. The patient had moderate eosinophilia and was seropositive for anti-Toxocara IgG antibody. Diagnosed with ocular toxocariasis, he was treated with systemic corticosteroids and albendazole with improvement in vision and fundus appearance.

Purpose To investigate the morphologic changes in Supramid Extra suture harvested from patients displaying recurrent ptosis who had undergone a frontalis suspension for congenital ptosis. Design Observational case series. Methods Using scanning electron microscopy, we examined the morphologic changes in Supramid Extra (S. Jackson Inc, Alexandria, Virginia, USA) harvested from 20 consecutive patients (23 eyelids) with recurrent ptosis who had undergone frontalis suspension. Disintegration was graded as mild, moderate, or severe. Results Examination of unused Supramid showed the smooth surface of the sheath and round, well-demarcated polyfilaments on cross section. However, implanted Supramid showed different degrees of disintegration. The surface of the sheath had a rough texture with cracks and peeling. On cross section, an accumulation of debris among the polyfilaments and irregular architectures with decreased diameters of the polyfilaments were noted in some cases. On the surface of polyfilaments, different degrees of debris were noted in all cases. The degree of the changes was not exactly correlated with either the time of the recurrence or the duration of implantation. However, as the duration of implanted Supramid increased, greater changes on the surface of the sheath were noted. With implantation of less than 37 months, mild changes (44%) were predominant; between 37 and 48 months, moderate changes (60%) were noted, and with more than 48 months of implantation, severe changes (44%) were predominant. Conclusions Supramid undergoes morphologic degradation by hydrolysis after implantation. This change might be considered one of the possible factors that facilitate the recurrence of ptosis.

Three-dimensional computed tomographic (3D-CT) angiography is a widespread imaging modality for intracranial vascular lesions. However, 3D-CT angiograms of an anterior communicating artery aneurysm associated with acute retrobulbar optic neuropathy have not been previously described. We present 3D-CT angiograms of an aneurysm of the anterior communicating artery that caused subarachnoid hemorrhage and vision loss in a 39-year old man. The 3D-CT angiograms were consistent with findings identified directly during surgery.

Purpose To introduce the clinical utility of the absolute value of the reconstructed waveform method in the analysis of multifocal visual evoked potential (mfVEP). Methods The mfVEP with 4-channel recording was performed using RETIscan® on 10 eyes of 10 normal subjects. Amplitudes were obtained from ring-shaped 6 areas and 4 sectors. The best visual evoked potential (VEP) response method and the absolute value of the reconstructed waveform method were compared in terms of analysis of the amplitudes. In order to assess the false positive rate of the examination, stimuli were administered with one-half of the cathode ray tube (CRT) monitor completely covered and the results were compared using 2 methods. Results The amplitudes in 6 areas and 4 sectors analyzed with the best VEP response method and the absolute value of the reconstructed waveform method showed no statistical difference (p > 0.05). The amplitude in the stimuli-blocked area of the absolute value of the reconstructed waveform method was smaller than that of the best VEP response method (p < 0.05) and the amplitude of the stimuli area showed no substantial difference between two methods (p > 0.05). Conclusions The absolute value of the reconstructed waveform method has similar reproducibility and lower level of false positives relative to the best VEP response method. Therefore, it can be considered as a useful method in the analysis of the mfVEP.

Purpose: To report herein on Nystagmus Acuity Estimator Function (NAEF) based on the foveation time, obtained by analyzing waveforms of infantile nystagmus patients and comparing the results with the patients' actual visual acuity. Methods: Electro-oculographic data of 27 patients with infantile nystagmus were reviewed. Data of patients only with jerk type nystagmus and reliable visual acuity were analyzed. The foveation time was measured, and NAEF was calculated and compared with the patients' actual best corrected visual acuity. Results: A correlation analysis of the patients' best corrected visual acuity with NAEF was performed, and the retrieved coefficient was 0.4266. The p-value calculated using the Pearson correlation coefficient was 0.0282, implying that high NAEF correlates positively with visual acuity. Conclusions: Estimated visual acuity, calculated based on the waveforms, positively correlates with the patients' actual visual acuity with statistical significance. However, since the foveation time can be measured only in the patients with jerk-type nystagmus waveforms, further study should be performed on the measurement of the foveation time with other waveforms. Furthermore, the present study shows that such analysis is possible with electrooculogram settings in most general hospitals.

Purpose: To explore the effects of stimulus duration, stimulus intensity, and background luminance on the amplitude and waveform of the ON- and OFF- responses of photopic ERG and to provide standard parameters of ON- and OFF- responses for normal Korean populations. Methods: Twenty normal subjects (20 eyes) were enrolled to record photopic ON-and OFF-responses using a contact lens electrode with built-in LEDs and an LED-driver. The influence of stimulus duration on wave amplitudes was studied at flash durations that varied from 5 to 200 ms. The influence of stimulus intensity was studied with 0.4, 0.7, 1.1, 1.4, 1.7, 1.9, 2.0, and 2.1 log cd/m2. In addition, the influence of background luminance was studied with 20, 30, 40, and 50 cd/m2. Result: Among 20 normal subjects, the d-waves in 16 subjects were isolated from b-waves with more than 50 ms of stimulus duration. The d-wave was observed for a 30-ms stimulus duration in 3 subjects and for a 100-ms duration in 1 subject. The amplitudes of the b-and d-waves increased as stimulus intensity was increased. The amplitudes of b-and d-waves decreased as background luminance was increased. Conclusions: Our results suggest that the clinical use of ON-and OFF-response recording can be obtained with stimulus parameters from 100 to 150 ms in duration and a 1.7-2.1 log cd/m2 intensity under 30-40 cd/m2 background luminance.

Purpose: Using corneal reflex, we performed intraoperative adjustments in horizontal strabismus patients who had very poor visual acuities with good compliance and analyzed various aspects of intraoperative adjustment. Methods: We retrospectively reviewed the records of patients with horizontal strabismus who underwent intraoperative adjustment using corneal reflex from May 1997 to April 2005. We evaluated various aspects of intraoperative adjustment. Results: Fifty-five patients (40 exotropes, 15 esotropes) were included in our study. 11 of 40 extropes (27.5%) and 4 of 15 esotropes (26.7%) eventually underwent operations that were adjusted intraoperatively. Successful results were seen in 35 of 40 exotropes (87.5%) and 8 of 15 esotropes (53.3%). Fifteen patients (27.3%) received intraoperative adjustments, and of these patients 11 (20.0%) who had successful results would have experienced either undercorrection or overcorrection if their operation were performed as scheduled. Four patients underwent operation on one muscle rather than on the scheduled two muscles. All 4 of these patients (100%) would have experienced significantly large overcorrection had they not received intraoperative adjustment. Conclusions: Patients who would have had difficulty with fixation due to low visual acuity could avoid under- or overcorrection and are expected to have higher success rates because of intraoperative adjustment using corneal reflex.